Integrated care in the emergency department: a complex adaptive systems perspective.

Nugus, P; Carroll, K; Hewett, DG; Short, A; Forero, R; Braithwaite, J

Integrated care in the emergency department: a complex adaptive systems perspective.

Nugus, P Carroll, K

Hewett, DG Short, A Forero, R Braithwaite, J

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Publication Type:: Journal Article
Citation:: Soc Sci Med, 2010, 71 (11), pp. 1997 - 2004
Issue Date:: 2010-12

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Field	Value	Language
dc.contributor.author	Nugus, P	en_US
dc.contributor.author	Carroll, K https://orcid.org/0000-0002-9110-1354	en_US
dc.contributor.author	Hewett, DG	en_US
dc.contributor.author	Short, A	en_US
dc.contributor.author	Forero, R	en_US
dc.contributor.author	Braithwaite, J	en_US
dc.date.available	2010-08-24	en_US
dc.date.issued	2010-12	en_US
dc.identifier.citation	Soc Sci Med, 2010, 71 (11), pp. 1997 - 2004	en_US
dc.identifier.uri	http://hdl.handle.net/10453/30813
dc.description.abstract	Emergency clinicians undertake boundary-work as they facilitate patient trajectories through the Emergency Department (ED). Emergency clinicians must manage the constantly-changing dynamics at the boundaries of the ED and other hospital departments and organizations whose services emergency clinicians seek to integrate. Integrating the care that differing clinical groups provide, the services EDs offer, and patients' needs across this journey is challenging. The journey is usually accounted for in a linear way - as a "continuity of care" problem. In this paper, we instead conceptualize integrated care in the ED using a complex adaptive systems (CAS) perspective. A CAS perspective accounts for the degree to which other departments and units outside of the ED are integrated, and appropriately described, using CAS concepts and language. One year of ethnographic research was conducted, combining observation and semi-structured interviews, in the EDs of two tertiary referral hospitals in Sydney, Australia. We found the CAS approach to be salient to analyzing integrated care in the ED because the processes of categorization, diagnosis and discharge are primarily about the linkages between services, and the communication and negotiation required to enact those linkages, however imperfectly they occur in practice. Emergency clinicians rapidly process large numbers of high-need patients, in a relatively efficient system of care inadequately explained by linear models. A CAS perspective exposes integrated care as management of the patient trajectory within porous, shifting and negotiable boundaries.	en_US
dc.language	eng	en_US
dc.relation.ispartof	Soc Sci Med	en_US
dc.relation.isbasedon	10.1016/j.socscimed.2010.08.013	en_US
dc.subject.classification	Public Health	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Negotiating	en_US
dc.subject.mesh	Emergency Service, Hospital	en_US
dc.subject.mesh	Efficiency, Organizational	en_US
dc.subject.mesh	Interdepartmental Relations	en_US
dc.subject.mesh	Delivery of Health Care, Integrated	en_US
dc.subject.mesh	Australia	en_US
dc.title	Integrated care in the emergency department: a complex adaptive systems perspective.	en_US
dc.type	Journal Article
utslib.citation.volume	11	en_US
utslib.citation.volume	71	en_US
utslib.location.activity	England	en_US
utslib.for	1608 Sociology	en_US
utslib.for	1601 Anthropology	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	11 Medical and Health Sciences	en_US
utslib.for	14 Economics	en_US
utslib.for	16 Studies in Human Society	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Arts and Social Sciences
pubs.organisational-group	/University of Technology Sydney/Faculty of Arts and Social Sciences/School of Education
utslib.copyright.status	closed_access
pubs.issue	11	en_US
pubs.publication-status	Published	en_US
pubs.volume	71	en_US

Abstract:

Emergency clinicians undertake boundary-work as they facilitate patient trajectories through the Emergency Department (ED). Emergency clinicians must manage the constantly-changing dynamics at the boundaries of the ED and other hospital departments and organizations whose services emergency clinicians seek to integrate. Integrating the care that differing clinical groups provide, the services EDs offer, and patients' needs across this journey is challenging. The journey is usually accounted for in a linear way - as a "continuity of care" problem. In this paper, we instead conceptualize integrated care in the ED using a complex adaptive systems (CAS) perspective. A CAS perspective accounts for the degree to which other departments and units outside of the ED are integrated, and appropriately described, using CAS concepts and language. One year of ethnographic research was conducted, combining observation and semi-structured interviews, in the EDs of two tertiary referral hospitals in Sydney, Australia. We found the CAS approach to be salient to analyzing integrated care in the ED because the processes of categorization, diagnosis and discharge are primarily about the linkages between services, and the communication and negotiation required to enact those linkages, however imperfectly they occur in practice. Emergency clinicians rapidly process large numbers of high-need patients, in a relatively efficient system of care inadequately explained by linear models. A CAS perspective exposes integrated care as management of the patient trajectory within porous, shifting and negotiable boundaries.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/30813